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Long-term Renal Preservation and Complication Profile With Ileal Ureter Creation.
- Source :
-
Urology [Urology] 2024 Jun; Vol. 188, pp. 138-143. Date of Electronic Publication: 2024 Apr 22. - Publication Year :
- 2024
-
Abstract
- Objective: To examine long-term ileal ureter replacement results at over 32 years at our institution. Long segment or proximal ureteral strictures pose a challenging reconstructive problem. Ureteroureterostomy, psoas hitch, Boari flap, buccal ureteroplasty, and autotransplantation are common reconstructive techniques. We show that ileal ureter remains a lasting option.<br />Methods: We performed a retrospective review of patients undergoing open ileal ureter creation from 1989-2021. Patient demographics, operative history, and complications were examined. All patients were followed for changes in renal function. Demographic data were analyzed and Cox proportional hazard models were performed.<br />Results: One hundred and fifty-eight patients were identified with median follow-up time of 40 months. Eighty-one percent had a unilateral ileal ureter creation. Fifty percent were female, median age was 53.3. Twenty-seven percent of patients had radiation-induced strictures. Preoperatively, 56.3% of patients were chronic kidney disease stage 1-2 and 43.7% were stage 3-5. Post-operatively, 54% were stage 1-2 and 46% were stage 3-5. Cox proportional hazard models demonstrated no significant correlation between worsening renal function and stricture cause, bilateral repair, complications, or sex (biologically male or female). Seventy-seven percent had no 30-day complications. Clavien complications included grade 1 (18), grade 2 (4), grade 3 (9), and grade 4 (5). Long-term complications included worsening renal function (3%), incisional hernia (8.2%), and small bowel obstruction (6.9%). Five (3.1%) patients ultimately required dialysis and 5 (3.1%) patients developed metabolic acidosis.<br />Conclusion: Ileal ureteral reconstruction is often a last resort for patients with complex ureteral injuries. Clinicians can be reassured by our long-term data that ileal ureteral creation is a safe treatment with good preservation of renal function and low risk of hemodialysis and metabolic acidosis.<br />Competing Interests: Declaration of Competing Interest The authors have no conflicts of interest to disclose.<br /> (Copyright © 2024 Elsevier Inc. All rights reserved.)
- Subjects :
- Humans
Female
Male
Retrospective Studies
Middle Aged
Adult
Kidney surgery
Time Factors
Aged
Follow-Up Studies
Urologic Surgical Procedures methods
Urologic Surgical Procedures adverse effects
Plastic Surgery Procedures methods
Plastic Surgery Procedures adverse effects
Ileum transplantation
Ileum surgery
Ureter surgery
Postoperative Complications epidemiology
Postoperative Complications etiology
Ureteral Obstruction surgery
Ureteral Obstruction etiology
Subjects
Details
- Language :
- English
- ISSN :
- 1527-9995
- Volume :
- 188
- Database :
- MEDLINE
- Journal :
- Urology
- Publication Type :
- Academic Journal
- Accession number :
- 38657870
- Full Text :
- https://doi.org/10.1016/j.urology.2024.04.025